title: Laparoscopic inguinal herniotomy in bladder exstrophy: a new solution to an old problem?
abstract: OBJECTIVE
  Laparoscopy is now the established management for infants with inguinal hernia at our institution. Open inguinal herniotomy in children with bladder exstrophy can be a difficult operation and is associated with a high rate of recurrence (15%). Here, we report our initial experience with laparoscopic repair of inguinal hernia in three children with bladder exstrophy.
  
  
  METHODS
  Three boys with repaired bladder exstrophy presented with inguinal hernia during follow up. The clinical presentation was bilateral in one and findings at surgery were bilateral open internal rings in two. Under general anaesthesia, pneumoperitoneum of 10 mmHg was raised with a Hasson port at the umbilicus. Two further instruments were inserted in the right and left flanks without ports. Two 4/0 Prolenetrade mark purse string sutures were placed to securely close the internal ring. The umbilicus was closed with an absorbable suture, and the skin incisions were closed with Indermil Gluetrade mark.
  
  
  RESULTS
  All infants made an uneventful recovery, being discharged within 24h. There were no complications. There has been no sign of recurrence during a mean follow up of 16 months.
  
  
  CONCLUSIONS
  Laparoscopic inguinal herniotomy is a technically straightforward and effective way to treat inguinal hernias in children with bladder exstrophy.
authors.affiliation: Department of Paediatric Urology, Great Ormond Street Hospital, London, UK.
authors.forename: Pedro-Jose
authors.initials: PJ
authors.lastname: Lopez
authors.forename: Imran
authors.initials: I
authors.lastname: Mushtaq
authors.forename: Joe I
authors.initials: JI
authors.lastname: Curry